Medicare Plans in Arkansas

Coverage and Benefits

Do you live in Arkansas? Are you 65 or older? Or will you be turning 65 soon? Then you are eligible to enroll in Medicare Plans in Arkansas. Traditional Medicare has two parts – Part A, and Part B – which are designed to cover most of a retired person’s health care needs. However, it does not cover 100% of all medical costs and procedures. These coverage gaps may need to be supplemented with additional or replacement insurance. We will discuss them in detail later on in this article.

Your employment history plays a part in determining what your Medicare premiums will be. Regardless of your history, you will be required to pay a premium for access to Medicare Part B. You may also be required to pay an additional premium for Part A if you have been employed for fewer than 40 quarters (or 10 years). Your Social Security Office can give you specific information on exact prices and requirements. Below is a table that outlines basic forms of Traditional Medicare coverage:

Medicare Part A (Hospital Coverage)

Inpatient care in hospitals

Skilled nursing facility care

Hospice care

Home health care

Medicare Part B (Medical Insurance)

Services from doctors and health providers

Outpatient care

Home health care

Durable medical equipment

Some preventive services

Medicare Part C (Medicare Advantage)

Includes all benefits and services covered under Part A and Part B

Usually includes Medicare prescription drug coverage (Part D) as part of the plan

Run by Medicare-approved private insurance companies

May include extra benefits and services for an extra cost

Medicare Part D (Drug Coverage)

Helps cover the cost of prescription drugs

Run by Medicare-approved private insurance companies

May help lower your prescription drug costs and help protect against higher costs in the future

Medicare Plans in Arkansas

The state of Arkansas has a grand total of 552,375 citizens currently enrolled in Medicare. Of those, 19% (104,951) have instead opted to take on a Medicare Advantage plan. But Medigap policies are more popular in Arkansas – 152,998 citizens have them (that’s nearly 28%!). The remaining 53% could be supplementing Original Medicare through an employer’s plan, or through a private one. Or they could be putting themselves at risk by having no supplemental coverage at all.

Before you read any further, make sure you are already enrolled in the Medicare program – residents can’t qualify for Arkansas Medicare supplement insurance without first being enrolled in the federal Medicare program.

Why are Medicare Supplement Plans so Important for Arkansas Residents?

Supplemental coverage is important because retirement incomes are dwindling while the cost of health care keeps going up. Without supplemental coverage, the gaps in Traditional Medicare could leave you with thousands of dollars in unexpected medical bills which your budget cannot accommodate. You can reference the table below for a few of these examples:

Medicare Part A Costs

Medicare Part B Costs

$1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services

Supplemental coverage protects you from spending hundreds or thousands of dollars per day for hospital services, as well as necessary outpatient expenses. There are several popular supplemental coverage options which can protect you and give you piece of mind. This article will cover the top two in further detail.

Your Arkansas Coverage Options: Medicare Supplement Plans

If you’ve ever heard the term “Medigap” before, it was most likely in reference to a Medicare supplement plan. They are specifically tailored to cover the most common “gaps” in Original Medicare. The ten government-approved plans are: A, B, C, D, F, G, K, L, M, and N. E, H, and I no longer exist. The Medicare Modernization Act rendered them obsolete in 2010, and they were taken out as a result. No matter what plan you choose, it will offer the same benefits as it would in any other state. The provider and overall costs, however, will vary by location.

Each plan offers the following benefits:

Plans

A

B

C

D

F

G

K

L

M

N

Part A Hospital Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Hospital Reserve Days

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Benefit For Blood

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Part B Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

*Co-Pays

Hospice Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Skilled Nursing Facility

✖

✖

✓

✓

✓

✓

50%

75%

✓

✓

Part A Deductible

✖

✓

✓

✓

✓

✓

50%

75%

50%

✓

Part B Deductible

✖

✖

✓

✖

✓

✖

✖

✖

✖

✖

Part B Excess Charges

✖

✖

✖

✖

✓

✓

✖

✖

✖

✖

Foreign Travel Benefit

✖

✖

✓

✓

✓

✓

✖

✓

✓

✓

Preventive Care Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Out of Pocket Limit

None

None

None

None

None

None

$4,620

$2,310

None

None

Co-Pays are $20 per office visit, and $50 per ER visit if not admitted to a hospital.** A checkmark indicates 100% coverage for the specified benefit.

Additional Arkansas Coverage Options: Medicare Advantage Plans

Medicare Advantage may also sometimes be referred to as Medicare Part C. Part C essentially replaces Original Medicare with a private health insurance plan. However, due to government mandates, that private plan must offer all of the same benefits as Part C. Some plans even offer additional benefits to entice potential customers. The important thing to understand is that the federal government will no longer be responsible for your health coverage if you go with a private insurer and purchase a Medicare Advantage plan.

Some of the extra benefits in Medicare Part C might include dental or prescription drugs (or even more options than that). However, many of the networks in which Medicare Advantage operates are highly restricted. Just keep in mind that, with Medicare Advantage, you run the risk of losing your current doctors if you happen to sign up for one of these restrictive networks.

Confused about Health Maintenance and Preferred Provider Organizations? HMOs and PPOs are the network of health care providers which work with your Medicare Advantage plan to provide you with care. Take a look at some of these plans near you:

Top HMO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$432

Humana Gold Plus H2012-082 (HMO)

Health and Drug

$36.00

$0

Top PPO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$0

HumanaChoice R5826-067 (Regional PPO)

Health Only

$0.00

$0

$0

Advantra Premier Plus (PPO)

Health and Drug

$0.00

$0

$1368

HumanaChoice R5826-010 (Regional PPO)

Health and Drug

$114.00

$310

Medigap vs. Medicare Advantage: Which is the Better Deal in Arkansas?

Comparing Medigap and Medicare Advantage can be difficult. Hopefully, this table can clear away some confusion:

Questions

Medicare Advantage

Medicare Supplement

How are the plans funded?

Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.

Your monthly premium takes care of the majority of your expenses.

Do I continue paying for Part B?

Yes

Yes

What does it cost me?

Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.

While each plan does require a monthly premium, many of them are affordably priced.

What does the plan cover?

Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.

All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.

Can I budget my health care expenses?

It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.

Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.

Can my plan be cancelled?

Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.

No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.

Are pre-approvals or pre-certifications required?

Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.

No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.

Can I use any doctor or hospital?

Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.

Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.

Can drug, vision, or dental coverage be included in the policy?

Yes.

No. These forms of coverage must be purchased separately.

Who is this plan type generally best suited for?

If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.

If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

More Helpful Medicare Resources in Arkansas

It’s important to do some research and clear up any confusion you may have regarding Arkansas Medicare supplemental insurance policies. Below is a helpful directory of contact information you can use to get answers to your health care inquiries. From there, you can make the decision that’s best for you.

HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.

PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.

Co-Pay: Amount of money charged per visit to doctor, specialist, etc.

Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.

Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.